Before we can begin to untangle the Gordian knot that we call the US healthcare delivery system, we need to understand the challenges and how we got here. It doesn’t help that industry experts disagree on the many, varied reasons and fingers are pointed in every direction. At Health Cost Matters we believe these problems are all intertwined.

According to author and physician, Atul Gawande, "Millions of Americans get tests, drugs, and operations that won’t make them better, may cause harm, and cost billions.” Drugs are prescribed that are ineffective (e.g., antibiotics for viral infections), or harmful (e.g., over-prescribing opioids following surgical procedures). Patients are subjected to redundant diagnostic tests because providers at one facility do not or will not accept the testing performed at other facilities. Surgical procedures (e.g., back and spinal, cardiac and arthroscopic procedures) are performed that have no or negative therapeutic value. Patients are subjected to painful services and diagnostic tests for untreatable and terminal conditions.

4.Medical Coding, Billing and Reimbursement Errors ... and Then There's Fraud, and Abuse.

Researching this topic we can readily find scores of expert opinions and explanations why pharmaceutical costs in the US are so expensive and outstrip the costs for the same drugs abroad. To name a few: Lack of price transparency. No price controls. Monopolies or limited competition. Inability of the government to negotiate lower prices.Cost of research, developing and bringing drugs to market.Small markets for important and specialized drugs. Fewer and higher priced generics. Advertising and marketing to providers and consumers. There are many, many reasons for runaway drug costs, but few solutions that policy makers can agree upon.

According to a study by the Henry Kaiser Foundation, “Uncompensated care fell by $6 billion nationwide in 2014,” to $29 billion, down from $35 billion in 2015. This decrease is largely a result of the ACA Medicaid expansion. (Providers located in poorer areas suffer greater losses from uncompensated care, and risk instability and insolvency when uninsured rates climb.) Whether the new administration defunds the Medicaid expansion in exchange for state block grants will determine the direction of uncompensated care. Either way, if you have insurance or pay taxes you participate in picking up this tab. If you live in an area where uncompensated care is particularly high, you risk losing providers.

How Do We Solve?

We believe solutions to this problem exist because failure is not an option. For ourselves and our children’s future, we (the US) must find solutions.

How can we begin to cure exorbitant health costs? There is no one solution, it's a journey. The first step is understanding what it is we’re trying to fix.

We welcome feedback and ideas from readers and thought leaders from all sides that are reasoned and not politically dogmatic.